Dr. Jim Painter, PhD, RD. University of Texas - Houston, School of Public Health Emeritus Professor Eastern Illinois University

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2 Dr. Jim Painter, PhD, RD University of Texas - Houston, School of Public Health Emeritus Professor Eastern Illinois University 2

3 Speaker Disclosure Board Member/Advisory Panel/Consultant Present Chic-fil-A, Sun-Maid Raisins, National Dairy Council, Tree Top Apples, Bush s Beans, United Sorghum Checkoff Board. Past American Heart Association Eat Well Task Force, California Raisin Marketing Board, Wonderful Pistachios, White Wave Foods, Davidson s Safest Choice Eggs Honoraria Honorarium underwritten by Today s Dietitian Dietitians of Canada, Exxon Mobil, Frito Lay, Midwest Dairy Council, Pennsylvania Nutrition Network, California Raisin Marketing Board, Alaska Tanker Company, Dairy Max, Texas AND, California AND, Florida AND, MINK, NY AND, South Carolina AND, Iowa AND, Nebraska AND, Manitoba Dairy Farmers, Dairy Farmers of Canada, Davidsons Safest Choice Eggs, National Dairy Council, New Products Conference, the Flavor Experience, BNP Media, and Cooper Vision. Author of Let s Eat Mindfully (2017) 3

4 Food and Health Survey 2016 INTERNATIONAL FOOD INFORMATION COUNCIL 4

5 4 out of 5 Americans are Trying to Lose Weight or Maintain their Current Weight Reprinted from the International Food Information Council Foundation, (2016) 5

6 Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 6

7 Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 7

8 Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 8

9 Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 9

10 Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 10

11 Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 11

12 Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 12

13 Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 13

14 Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 14

15 Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 15

16 Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 16

17 Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 17

18 Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 18

19 Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 19

20 Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 20

21 Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 21

22 Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 22

23 Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 23

24 Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 24

25 Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 25

26 Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 26

Highest Percentage of Obesity by Countries, 2014 50 45 40 35 30 25 20 15 10

27 Highest Percentage of Obesity by Countries, World Health Organization. 27

Trust for America s Health F as in Fat: How Obesity Threatens

28 Projected 2030 Obesity Rates <54% 54% -59.9% >60% National Heart Forum, Robert Wood Johnson Foundation, Trust for America s Health F as in Fat: How Obesity Threatens America s Future Percentage of adult population projected to be medically obese in

29 Used with permission from Gary Foster Penn State ADA 29

30 Are poor food choices the cause? Why are Americans gaining weight I. Lack of exercise II. Sedentary lifestyles III. Stress/pressure IV. Advertising V. Genetic VI. Deep emotional needs, Dr Phil VII. Haven t found the right diet Premise for today! We lose track of how much we are eating 30

31 What Affects Consumer Choice? 1. Portion Size 2. Shape and Size 3. Visibility 4. Food Labels 5. Visual Cues 6. Suggestive Selling 7. Social Pressures 31

32 I. Portion size 1. Portion Distortion 2. Restaurants 32

33 Historical Glance Food/Bev Introduction Size at intro(oz) 2002 sizes Budweiser , 12, 22, 40 Hershey bar , 2.6, 4.0, 7.0, 8.0 BK fry , 4.1, 5.7, 6.9 McD burger , 3.2, 4.0, 8.0 Soda-BK , , 16.0, 22.0, 32.0, 42.0 Young & Nestle, JADA Expanding Portion Sizes in the us Marketplace. ( ) 33

34 Then and Now... Average Cookies 20 years ago 55 calories 1.5 inch diameter Now 275 calories 3.5 inch diameter Portion Distortion by the National Heart, Lung, and Blood Institute: 34

35 Then and Now... Average Cheesecake 20 years ago 260 calories 3 ounces Now 640 calories 7 ounces Portion Distortion by the National Heart, Lung, and Blood Institute: 35

36 Then and Now... Average Muffins 20 Years Ago 210 calories 1.5 ounces Today 500 calories 4 ounces Portion Distortion by the National Heart, Lung, and Blood Institute: 36

the National Heart, Lung, and Blood Institute: https://www.

37 Then and Now Average Bagel 20 years ago 3 in diameter 140 calories Today 6 in diameter 350 calories Portion Distortion by the National Heart, Lung, and Blood Institute: 37

Then and Now Average Spaghetti 20 years ago 1 C.

and Blood Institute: https://www.nhlbi.nih.

38 Then and Now Average Spaghetti 20 years ago 1 C. pasta and sauce w/ 3 meatballs 500 calories Today 2 C. pasta and sauce w/3 meatballs 1,025 calories Portion Distortion by the National Heart, Lung, and Blood Institute: 38

39 Then and Now Average Burger 20 years ago 333 calories Portion Distortion by the National Heart, Lung, and Blood Institute: 39

National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.

40 Then and Now Average Burger 20 years ago 333 calories Today 590 calories Monster Burger 1420 calories Portion Distortion by the National Heart, Lung, and Blood Institute: 40

41 Then and now Average Fries 20 years ago 2.4 oz 210 calories Today 6.9 oz 610 calories Portion Distortion by the National Heart, Lung, and Blood Institute: 41

42 From the monster to the Riley burger 42

700 Calorie Comparison of 7-eleven Coke-a-Cola 600 500 400 300 Calories

43 700 Calorie Comparison of 7-eleven Coke-a-Cola Calories Gulp (20oz) Big Gulp (30oz) Super Gulp (40oz) Double Gulp (50oz) 43

44 Legislation on Portion Sizes: Bloomberg New York state Supreme Court Judge Milton Tingling declared invalid Mr. Bloomberg's plan to prohibit selling sugary drinks in cups or containers larger than 16 ounces. Was to go in effect in March 2013 The Wall Street Journal Judge Cans Soda Ban. Retrieved from 44

45 Other Trends Nestle Toll House cookies recipe yields 60 vs. 100 when written in

46 Super Size Me Documentaries 46

47 CBS Morning Show Features: Portion Size Me 47

48 Amount of Soda Consumed (fl oz) Does Cup Size Increase Soda Consumption 18 Figure 1. Average Soda Consumption Over 100% increase! fl oz cups 32 fl oz cups Schuster, M. J., Heiser, L., Fink, J. N., Mackenzie, J. A., Carlson, J. R., Roche, J. D., & Painter, J. E. (2014). Does Larger Cup Size Increase Soda Consumption?. Journal of the Academy of Nutrition and Dietetics, 114(9), A62. 48

49 II. Size and Shape of Containers General Finding About Package Size... Study 1. Package Size Study 2. Portion Size Study 3. Serving Shapes Study 4. Shape Study #2 49

50 Package Size Increases Consumption People who pour from larger containers eat more than those pouring from small General Finding: Package Size Can Double Consumption Spagetti Crisco Oil M&Ms "Small-x" "Medium-2x" "Large 3x" Wansink, Brian (1996), Can Package Size Accelerate Usage Volume? Journal of Marketing, Vol. 60:3 (July),

51 The 100-Calorie Semi-Solution: Sub-Packaging Most Reduces Intake Among The Heaviest Four small 100 calorie packages One large 400 calorie package BMI 25 BMI <25 Wansink, B., Payne, C. R., & Shimizu, M. (2011). The 100 Calorie Semi Solution: Sub Packaging Most Reduces Intake Among The Heaviest. Obesity, 19(5),

52 Hungry for Some Stale Movie Popcorn? Does portion size effect consumption? Wansink, Brian and SeaBum Park (2001), At the Movies: How External Cues and Perceived Taste Impact Consumption Volume, Food Quality and Preference, 12:1 (January),

53 We Eat Much More from Big Containers People eat 45-50% more from extra-large popcorn containers They still eat 40-45% more with stale popcorn Fresh Large Bucket 10 Days Old Extra- Large Buckets Wansink, Brian and SeaBum Park (2001), At the Movies: How External Cues and Perceived Taste Impact Consumption Volume, Food Quality and Preference, 12:1 (January),

Do Peripheral Cues Influence Experts 48 Philadelphia bartenders with Precise Target Volumes? Given 4 tall, slender (highball) glasses or 4 short, wide (tumbler) glasses Split in to.

54 Do Peripheral Cues Influence Experts 48 Philadelphia bartenders with Precise Target Volumes? Given 4 tall, slender (highball) glasses or 4 short, wide (tumbler) glasses Split in to... Less than 5 years experience More than 5 years experience Highball Glass Tumbler Wansink, B., & van Ittersum, K. (2003). Bottoms up! Peripheral cues and consumption volume. Journal of Consumer Research, 30(3),

When in Philadelphia, Should I Ask for a Tumbler or a Highball Glass? 2.5 2 1.

55 When in Philadelphia, Should I Ask for a Tumbler or a Highball Glass? < 5 years 5+ years Bartenders poured 28% more alcohol into tumblers than highball glasses Experience doesn t eliminate bias Tall High Ball Glass Short Tumbler Glass Wansink, B., & van Ittersum, K. (2003). Bottoms up! Peripheral cues and consumption volume. Journal of Consumer Research, 30(3),

56 Do Serving Container Shapes Bias Consumption? Piaget s Conservation of Volume: Kids think tall vessels hold more than wide vessels 56

57 Do Serving Container Shapes Bias Consumption? 133 adolescents at a Nutrition & Fitness Camp in NH Cafeteria at breakfast time Each was randomly given one glass when arriving Tall narrow juice glass or a Short wide juice glass 57

58 Amount of Soda Consumed (fl oz) Does Cup Size Increase Soda Consumption 18 Figure 1. Average Soda Consumption Over 100% increase! fl oz cups 32 fl oz cups Schuster, M. J., Heiser, L., Fink, J. N., Mackenzie, J. A., Carlson, J. R., Roche, J. D., & Painter, J. E. (2014). Does Larger Cup Size Increase Soda Consumption?. Journal of the Academy of Nutrition and Dietetics, 114(9), A62. 58

59 III. The Effect of Visibility and Convenience on Dietary Consumption The Past.. Gas stations Someone else pumped the gas Fast food You had to go into the restaurant 59

60 Research Questions 1. Do people eat more when food is in sight? 2. Do people eat more when food is within reach? 60

61 Intervention: METHODS Closed candy container containing 30 Hershey kisses replenished daily Three conditions: On top of the desk (visible & convenient) In a desk drawer (not visible & convenient) Away from desk (inconvenient) 61

62 Amount of Candy Consumption According to Condition 10 # of Candies Consumed On Desk In Desk 2 Meters from Deks Painter, J., Wansink, B., Hieggelki, J. (2002). How Visibility and Convenience Influence Candy Consumption. Appetite 38,

63 Would this be seen with other types of foods? 63

64 Study design: Methods 4 foods, grapes, chocolate, carrots & pretzels, were placed in one of 2 conditions Two conditions: On top of the desk (visible & accessible) In a desk drawer (not visible & inaccessible) Painter, J., Snyder, J., Rhodes, K., Deisher, C The Effect of Visibility and Accessibility of Food on Dietary Intake, Journal of the American Dietetic Association, 108(9), A-93 64

65 Increase in Dietary Intake When Food is Visible (on desk) Compared to Invisible (in desk) Percent increase Grapes Chocolate Carrots Pretzels Painter, J., Snyder, J., Rhodes, K., Deisher, C The Effect of Visibility and Accessibility of Food on Dietary Intake, Journal of the American Dietetic Association, 108(9), A-93 65

66 Average Consumption of Raisin Boxes Accessibility and Visibility of Raisins % % Drawer (5) Desk (5) Desk (10) Placement and Portions of Raisins Raisins Boxes Gaydosh, B., & Painter, J. (2010). The effect of visibility and quantity of raisins on dietary intake, a pilot study. Journal of the American Dietetic Association, 110(9): A32. DOI: /j.jada

67 IV. Can Labels Change the Taste of Foods? Study 1. Descriptive Labels in the Cafeteria 67

68 Menu Items Used Red beans & rice Seafood filet Grilled chicken Chicken Parmesan Chocolate Pudding Zucchini cookies Traditional Cajun Red beans & rice Succulent Italian Seafood filet Tender Grilled chicken Home-style Chicken Parmesan Satin Dutch Chocolate Pudding Grandma s Zucchini cookies 68

69 Consumer Ratings Well, I know what I like --> Maybe Not People evaluate descriptive foods as more favorable Plain Descriptive What We Say About Food Affects Our Perception of the Food Taste Texture Calories Wansink, Brian, James M. Painter, and Koert van Ittersum, (2001) Descriptive Menu Labels Effect on Sales, Cornell Hotel and Restaurant Administrative Quarterly, 42:6 (December),

70 Results: Effects are Less Strong with Desserts Taste Desserts Main & Side Dishes No Label Label Wansink, Brian, James M. Painter, and Koert van Ittersum, (2001) Descriptive Menu Labels Effect on Sales, Cornell Hotel and Restaurant Administrative Quarterly, 42:6 (December),

71 Fine as North Dakota Wine California-labeled wine North Dakota-labeled wine 1 0 Expected Tastiness of Wine Expected Rating of Wine Tastiness Rating of Cheese Wansink, B., Payne, C. R., & North, J. (2007). Fine as north dakota wine: Sensory expectations and the intake of companion foods. Physiology & Behavior, 90(5), doi: /j.physbeh

72 V. Visual cues 1. Soup 2. Pistachios 72

73 Soup Study 54 participants ½ were give a normal bowl ½ were give a refillable bowl Details were not provided about the study 73

74 Refillable Soup Bowls Increase Consumption, but Not Perception of Consumption Estimated Calories Consumed Actual Calories Consumed Normal Soup Bow Refilling Soup Bowl Wansink, B., Painter, JE., North, J Bottomless Bowls: Why Visual Cues of Portion Size May Influence Intake. Obesity Research, 13,1,

75 Key Thoughts: Don t overhaul your life make small changes Don t make huge changes all at once, just small changes consistently A lifestyle change, not a diet, works in the long-term 75

76 Study 2 Will the presence of the empty shells reduce consumption? Methods: Population 17 faculty & staff Two conditions Empty shells left on table (visible) Empty shells were cleared 76

77 Calories Calorie Consumption Comparing Empty Shells Visible to Shells Cleared Differences were significant p Shells visible Shells cleared Calories consumed An increase of 56% when shells were cleared Kennedy-Hagan, K., Painter, J. E., Honselman, C., Halvorson, A., Rhodes, K., & Skwir, K. (2011). The effect of pistachio shells as a visual cue in reducing caloric consumption. Appetite, 57(2),

78 Satiety of Portions ** No significant differences, P Shells visible Shells cleared Full Even though consumption increased by 56%, there was no significant difference in satiety ** Fullness Scale (1) very Hungry (5) very full Kennedy-Hagan, K., Painter, J. E., Honselman, C., Halvorson, A., Rhodes, K., & Skwir, K. (2011). The effect of pistachio shells as a visual cue in reducing caloric consumption. Appetite, 57(2),

79 Do Pre-Meal To-Go Boxes Affect the Amount of Food Consumed in a Restaurant Setting? Schuster, M. J., Carlson, J. R., Mackenzie, J. A., Roche, J. D., Brooks, T. L., & Painter, J. E. (2014). Do Pre-Meal To-Go Boxes Affect the Amount of Food Consumed in a Restaurant Setting?. Journal of the Academy of Nutrition and Dietetics, 114(9), A62. 79

80 Amount of Spaghetti Consumed (oz) Average Spaghetti Consumption Pre-meal To-go Box, oz Post-meal To-go Box, oz 80

81 VI. People around you when eating The Effects of Suggestive Selling by Wait Staff on Food Consumption Social Pressures on Consumption 81

82 Subjects Materials and Methods Eastern Illinois University Students Restaurant Setting: Served initial serving of a beverage, a roll, soup, pasta and a cookie Zumwalt, G. (2008). The effect of suggestive selling by wait staff on food consumption. 82

83 Average oz/# of items Comparison of Food Items Significantly Differs Between Groups Roll Pasta Cookie Treatment Control Zumwalt, G, K Kennedy-Hagan, C Honselman, K Rhodes, and J Painter. "The Effect of Suggestive Selling by Wait Staff on Food Consumption." Journal of the American Dietetic Association, (2008): A39. 83

84 VI. People around you when eating The Effects of Suggestive Selling by Wait Staff on Food Consumption Social Pressures on Consumption 84

85 The Effect of Social Pressure On The Eating Habits of College Students in a Restaurant Environment Treatment: Research Assistant said yes to 2nd portion Control: Research Assistant said no to 2nd portion. Wilcox, D., Kennedy-Hagan, K., Rhodes, K., Wilkinson, R., & Painter, J. (2008). The effect of social pressure on the eating habits of college students in a restaurant environment. Journal of the American Dietetic Association, 108(9), A40. 85

86 The Effect of Social Pressure On The Eating Habits of College Students in a Restaurant Environment 250 % of Increase in Each Food Item Lasagna Dessert Beverage fills Salad Breadstick Wilcox, D., Kennedy-Hagan, K., Rhodes, K., Wilkinson, R., & Painter, J. (2008). The effect of social pressure on the eating habits of college students in a restaurant environment. Journal of the American Dietetic Association, 108(9), A40. 86

87 Applications for Your Clients I. Choose smaller portions I. Value priced meals are not good for your waistline II. Smaller containers & packages decreases consumption I. People eat 92% of what is served on their plate II. Best strategy: serve less in the first place! 87

88 Applications for Your Clients, cont. III. Use smaller eating utensils I. Using smaller plates, bowls, cups and silverware decrease consumption without decreasing satiety IV. Visual cues influence consumption III. Make small changes in presentation, garnishes and description you give the family to make healthier more appealing 88

89 Applications for Your Clients, cont. V. Less visible & convenient = less consumption I. Foods to eat more make them visible & convenient II. Foods to eat less make them hard to see and inconvenient VI. Be aware of the influence of those you eat with I. Check with your hunger and how much you have eaten before saying yes to more foods 89

90 Thank You! 90

91 Want to Read More? Find it on amazon.com 91

92 @DrJimPainter wwww.drjimpainter.com 92

93 Credit Claiming You must complete a brief evaluation of the program in order to obtain your certificate. The evaluation will be available for 1 year; you do not have to complete it today. Credit Claiming Instructions: 1. Log in to and go to My Courses and click on the webinar title. 2. Click Take Course on the webinar description page. 3. Select Start/Resume Course to complete and submit the evaluation. 4. Download and print your certificate. 93

Let s Eat Mindfully! Dr. Jim Painter, PhD, RDN University of Texas Houston, School of Public Health

Let s Eat Mindfully! Dr. Jim Painter, PhD, RDN University of Texas Houston, School of Public Health 1 Dr. Jim Painter, PhD, RD University of Texas - Houston, School of Public Health Emeritus Professor